title: Hypoxia imaging with 18F-fluoroerythronitroimidazole integrated PET/CT and immunohistochemical studies in non-small cell lung cancer.
abstract: OBJECTIVE
  (18)F-fluoroerythronitroimidazole ((18)F-FETNIM) PET/CT allows a noninvasive assessment of tumor hypoxia. The purpose of this study was to evaluate a noninvasive and simplicity parameter for quantization of (18)F-FETNIM uptake with expectations to predict survival in non-small cell lung cancer surgical patients and investigate the relationship between (18)F-FETNIM uptake and molecular markers related to hypoxia, glucose metabolism, and angiogenesis.
  
  
  METHODS
  Thirty-two patients with biopsy-proven non-small cell lung cancer for surgical treatment were enrolled from March 2007 to February 2011. All patients had PET/CT studies with (18)F-FETNIM and subsequently underwent surgery. Twenty-five patients had stage II disease of surgical staging only for statistical analysis. The tumor-to-mediastinum (T/Me) ratio was calculated and correlated with survival and immunohistochemical staining of hypoxia inducible factor 1α (HIF-1α), glucose transporter 1 (GLUT-1), and vascular endothelial growth factor (VEGF).
  
  
  RESULTS
  The actuarial survival was worse for patients showing a high T/Me ratio, the best discriminative cutoff value being 1.9. A statistically significant worse survival was noted in patients having a tumor with a T/Me ratio of 1.9 or greater, compared with patients showing a tumor with a T/Me ratio of less than 1.9, a 3-year survival of 43.8% and 88.9%, respectively (P = 0.034). There was a positive correlation between T/Me ratio and HIF-1α (P = 0.023), GLUT-1 (P = 0.035), and VEGF (P = 0.042).
  
  
  CONCLUSIONS
  T/Me ratio provides a noninvasive parameter for quantization of (18)F-FETNIM uptake on PET/CT. T/Me ratio is correlated with a worse outcome and with the expression of HIF-1α, GLUT-1, and VEGF, all up-regulated under hypoxic conditions.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
authors.forename: Man
authors.initials: M
authors.lastname: Hu
authors.forename: Ligang
authors.initials: L
authors.lastname: Xing
authors.forename: Dianbin
authors.initials: D
authors.lastname: Mu
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Yang
authors.forename: Guoren
authors.initials: G
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Kong
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000098:blood supply / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D015687:Cell Hypoxia; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009389:Neovascularization, Pathologic; D009593:Nitroimidazoles; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D009593:Nitroimidazoles; C092114:fluoroerythronitroimidazole; D005947:Glucose